Functional Medicine/Nutrition

Functional medicine is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, functional medicine addresses the whole person, not just an isolated set of symptoms. Functional medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease. In this way, functional medicine supports the unique expression of health and vitality for each individual.

Why Do We Need Functional Medicine?

Our society is experiencing a sharp increase in the number of people who suffer from complex, chronic diseases, such as diabetes, heart disease, cancer, mental illness, and autoimmune disorders like rheumatoid arthritis.

The system of medicine practiced by most physicians is oriented toward acute care, the diagnosis and treatment of trauma or illness that is of short duration and in need of urgent care, such as appendicitis or a broken leg. Physicians apply specific, prescribed treatments such as drugs or surgery that aim to treat the immediate problem or symptom.

Unfortunately, the acute-care approach to medicine lacks the proper methodology and tools for preventing and treating complex, chronic disease. In most cases it does not take into account the unique genetic makeup of each individual or factors such as environmental exposures to toxins and the aspects of today’s lifestyle that have a direct influence on the rise in chronic disease in modern Western society.

There’s a huge gap between research and the way doctors practice. The gap between emerging research in basic sciences and integration into medical practice is enormous—as long as 50 years— particularly in the area of complex, chronic illness.

Most physicians are not adequately trained to assess the underlying causes of complex, chronic disease and to apply strategies such as nutrition, diet, and exercise to both treat and prevent these illnesses in their patients.

How is Functional Medicine Different?

Patient-centered care. The focus of functional medicine is on patient-centered care, promoting health as a positive vitality, beyond just the absence of disease. By listening to the patient and learning his or her story, the practitioner brings the patient into the discovery process and tailors treatments that address the individual’s unique needs.

An integrative, science-based healthcare approach. Functional medicine practitioners look “upstream” to consider the complex web of interactions in the patient’s history, physiology, and lifestyle that can lead to illness. The unique genetic makeup of each patient is considered, along with both internal (mind, body and spirit) and external (physical and social environment) factors that affect total functioning.

Integrating best medical practices. Functional medicine integrates traditional Western medical practices with what are sometimes considered “alternative” or “integrative” medicine, creating a focus on prevention through nutrition, diet, and exercise; use of the latest laboratory testing and other diagnostic techniques; and prescribed combinations of drugs and/or botanical medicines, supplements, therapeutic diets, detoxification programs, or stress-management techniques.

Working with a Functional Medicine Practitioner

Functional medicine practitioners promote wellness by focusing on the fundamental underlying factors that influence every patient’s experience of health and disease. The Functional Medicine Approach to Assessment The Institute for Functional Medicine teaches practitioners how to assess the patient’s fundamental clinical imbalances through careful history taking, physical examination, and laboratory testing. The functional medicine practitioner will consider multiple factors, including:

Environmental inputs – The air you breathe and the water you drink, the particular diet you eat, the quality of the food available to you, your level of physical exercise, and toxic exposures or traumas you have experienced all affect your health.

Mind-body elements – Psychological, spiritual, and social factors all can have a profound influence on your health. Considering these areas helps the functional medicine practitioner see your health in the context of you as a whole person, not just your physical symptoms.

Genetic makeup – Although individual genes may make you more susceptible to some diseases, your DNA is not an unchanging blueprint for your life. Emerging research shows that your genes may be influenced by everything in your environment, as well as your experiences, attitudes, and beliefs. That means it is possible to change the way genes are activated and expressed.

Through assessment of these underlying causes and triggers of dysfunction, the functional medicine practitioner is able to understand how key processes are affected. These are the body’s processes that keep you alive. Some occur at the cellular level and involve how cells function, repair, and maintain themselves. These processes are related to larger biological functions, such as:

how your body rids itself of toxins

regulation of hormones and neurotransmitters

immune system function

inflammatory responses

digestion and absorption of nutrients and the health of the digestive tract

structural integrity

psychological and spiritual equilibrium

how you produce energy

All of these processes are influenced by both environmental factors and your genetic make-up; when they are disturbed or imbalanced, they lead to symptoms, which can lead to disease if effective interventions are not applied.

A Comprehensive Approach to Treatment

Most imbalances in functionality can be addressed; some can be completely restored to optimum function, and others can be substantially improved.

Prevention is paramount. Virtually every complex, chronic disease is preceded by long-term disturbances in functionality.

Changing how the systems function can have a major impact on the patient’s health. The functional medicine practitioner examines a wide array of available interventions and customizes a treatment plan including those with the most impact on underlying functionality.

Functional medicine expands the clinician’s tool kit. Treatments may include combinations of drugs, botanical medicines, nutritional supplements, therapeutic diets, or detoxification programs. They may also include counseling on lifestyle, exercise, or stress-management techniques.

The patient becomes a partner. As a patient, you become an active partner with your functional medicine practitioner. This allows you to really be in charge of improving your own health and changing the outcome of disease.

OVERVIEW

A functional medicine approach to health and medical treatment is a different way of thinking. Instead of just treating symptoms, we look upstream as far as we can to find the cause of health problems and not just ways to treat the symptoms or complaints. It is this approach that may discover a dairy or wheat allergy as a trigger for recurrent ear infections which had been treated many times previously by just giving an antibiotic. It is this approach that treats eczema, not by just giving a hydrocortisone cream for the rash, but by looking deeper for the cause. We may look at intestinal permeability and an unregulated immune system reaction. By addressing vitamin D and essential fatty acid undernutrition, we can improve intestinal friendly bacteria which actually treat the triggers for the eczema.

The functional medicine approach not only uses normal western medicine as a bridge to help or treat conditions, but also uses food as medicine, natural products as healing agents and nutrients and vitamins as components to encourage health of the client. It is this functional medicine approach that also acknowledges that what we wash our genes in everyday, affects our health. It appreciates the epigenetics of our lifestyle, how our lifestyle affects our genes. It appreciates the fact that over 90% of people who geographically live above the 35th parallel are vitamin D deficient, and that 50% of Caucasians have problems activating folate. By looking at an individual’s cellular function we can change and improve health.

Everyone is unique. We are each as unique as our fingerprint. No one in the history of mankind has the same fingerprint, the same physiology, the same influences while growing up, or the same life experience. We know this is important. Our approach to each patient tries to honor this uniqueness. We try to get to the root causes of chronic medical problems instead of just trying to treat the symptoms. This requires a different way of thinking. For every chronic condition there is usually a malfunction in two or three different major physiologic areas of control. We try to address the seven different areas of what we call the functional medicine matrix.

DIGESTION AND ABSORPTION

We know that if we do not address the gut and many of its dynamic processes we often miss the cause of illness. The lining of your gut turns over every 14 to 21 days. The lining of your intestine makes up 70% of your immune system. We know that the mucosal barrier of your intestine is the thin film between everything we eat and the activation of our immune system. This is why we often address patients’ digestion and absorption. Do we have enough digestive enzymes? Do we have too much or too little acid? Is the quality of our food such that it encourages healthful change in our situation? Do we eat enough fiber? Do we have the right types of carbohydrates? Are we taking in the rich orchestra of fruits and vegetables every day that offers the molecules to our metabolism that allow us to be healthy and not trigger illness? Are we washing our genes with molecules, vitamins and nutrients that encourage healthy processes to be turned on and not turned off?

We encourage everyone who comes to our clinic to examine their diet mindfully and inquire of themselves whether there are any issues in the diet and food choices they make that alter their health. We have added to the staff to help our providers with this. Emily Rydbom, Certified Nutrition Consultant and Certified Lifestyle Educator has further training in functional medicine, functional nutrition, first-line therapies, and food as medicine and will work with you to create a nutritional and lifestyle plan that is personalized and sustainable.

INFLAMMATION AND IMMUNE SURVEILLANCE

There are many different triggers that promote inflammation in the body. Environmental triggers in our lifestyle can alter how our immune system functions. What turns our immune system up or down? We know many of the things we eat will promote immune system balance. Many of the different herbs that we use in cooking help balance our system. Different infections, allergies, stressors and habits all impact our immune system.

Getting the right balance of nutrients allows us to balance our immune system in such a way to promote the correct response to our environment. We focus on trying to bring a balance into our patients lives so inflammation or an overactive immune system can be quieted and improve symptoms. Many conditions can be exacerbated by inflammation, including asthma, arthritis, irritable bowel, colitis, atopic dermatitis, eczema, psoriasis, myalgias, fibromyalgia and heart disease. By addressing the imbalance in the immune system we can help or cure disease.

OXIDATIVE STRESS

All metabolic processes in our body require energy. That energy is made by small organelles called mitochondria within each of our cells. There are thousands of mitochondria in cells. Think of all the energy that is required for your heart cells to beat your whole life. There are thousands and thousands of mitochondria in our hundred trillion cells. For energy to be made efficiently, our metabolism needs antioxidants such as vitamin C, vitamin E and zinc, to name a few. Different things in the environment put stress on our mitochondria so they don’t work well. These stressors include heavy metals like lead, mercury or cadmium, many pesticides and breakdown products of different medications.

Conditions as common as migraine headaches or as rare as Lou Gehrig’s disease are worsened by poorly working mitochondria. Parkinson’s disease, tingling in the hands, ADHD and autism can be improved by improving the function of poorly working, energy-producing mitochondria. We have to balance the nutrient and diet intake of essential vitamins and minerals in our diet with the needs of our body and its trillions of mitochondria. This is one of the areas we address when a patient presents with a chronic condition. Are you getting enough antioxidants? Do you eat enough foods that are rich in the antioxidants that help cells function correctly?

DETOXIFICATION AND BIOTRANSFORMATION

When we talk about detoxification, we are talking about how each of us takes things that we are exposed to in our environment and transforms them to use or expel them. The liver is the main organ that deals with transforming and detoxifying molecules, although every tissue in our body has some role in detoxifying or transforming molecules to be used or expelled. Organs such as the brain, lungs, kidneys and intestine all play a catalyst role in detoxification and biotransformation.

There are at least four different ways our bodies get rid of waste products and toxins. Phase 1 detoxification requires mainly minerals and vitamins. Phase 2 detoxification requires good-quality proteins. Proteins are made up of essential and non-essential amino acids. We have to have the right balance of good proteins in our diet for our pathways to work, because toxic molecules are excreted through these many pathways. Phase 3 detoxification occurs in the intestinal lining. Our intestinal health is important to keeping our bodies detoxification system balanced. Phase 4 detoxification and biotransformation is influenced mainly by an acid/base balance. We know that with an increased alkaline diet, there is greater detoxification of molecules via the kidneys. The correct diet for our individual detoxification program is important for your improved health.

Medications and their byproducts can alter how well we detoxify. Prescription and over-the-counter medications have increased in use and availability over the last 100 years. We know that for every additional medication taken, there is a 10% increase in the frequency of medication-to-medication interactions. This means that if you’re taking 10 prescription or over-the-counter medications, you have a 100% chance of having some type of drug-drug interactions. These interactions and their side effects can range from subtle to severe. By looking at a comprehensive list of medications and your individual detox systems’ functioning, we can decrease the chance of adverse reactions to medications. Part of our job is to help people go through those lists of medications, nutrients and herbs to figure out how to simplify, thus decreasing the chance of any interaction.

NEUROENDOCRINE

Hormones and neurotransmitters help us function normally. All of us are very familiar with hormones that help us grow taller. Hormones help us transition from infancy to childhood, from childhood to adolescence, and from adolescence to adulthood. It is the hormones and neurotransmitters that allow us to react to stress, to joy and love, to anger and fear. The balancing of these hormones and of neurotransmitters allows us to live more healthfully.

In our society there is increased use of antidepressants and anti-anxiety drugs. There is increased recreational drug use, a doubling of the use over-the-counter sleep aids, and natural supplemental combinations in an attempt to bring balance and rest. Serotonin, GABA, dopamine and adrenaline all balance each other out in ways that can promote anxiety, relaxation, sleep or wakefulness. There are many different things that affect the formation and use of neurotransmitters. Do you have enough B6 or is it activated fully? Do you have enough vitamin D or magnesium, riboflavin, thiamine or SAMe to allow your neurotransmitters to be balanced? Are you sleeping normally or enough? Is light hitting your eyes between 11 p.m. and 4 a.m.? All these things can affect neurotransmitter and hormone balance. These are all questions to ask if any of us have a chronic condition. What about menopause, irregular periods, male andropause or osteoporosis and osteopenia? These conditions are affected by our stress level, our ability to sleep, our diet and the neuroendocrine balance.

MIND-BODY AND SPIRITUAL EQUILIBRIUM

Thoughts, stress, faith, spiritualism, belief, hope, joy, contentment and life perspective affect our health and our ability to heal. It is by practicing and developing habits of faith, meditation, prayer, quiet time, and visualization that our health and life are balanced. Often the current medical model does not address this; it is not discussed or its’ role in chronic health problems is not considered. By acknowledging and addressing this aspect of our life we can impact health. How ready am I for change? How ready am I to develop new habits? How ready am I to seek help? Can I find peace with my condition and move forward? Do I have a faith that I practice? Do I have practices that allow me to relax? Have I ever used biofeedback to improve my health or condition? Am I ready to change for the health of it? These are critical questions in our healing and health.

STRUCTURAL

When our structure changes, the function changes. This is obvious when you think of someone with a broken leg. With the leg in a cast, it is more difficult to walk, and the person’s gait is changed. The structure of our membranes affects our health also. Every cell is surrounded by a very thin and pliable membrane. It takes 10 cell membranes to equal the thickness of a single piece of paper. If you took all of our cells’ membranes and put them side to side and end to end, the resulting tissue would cover a 100 mi.².

The health of the cell membrane allows our organs to communicate with each other, and allows us to communicate with other people. The membranes allow neurotransmitters to be released to the surface and in between nerves. Those connections trigger our thoughts, our concerns, our stress or our relaxation. The health of our cell membranes affects the health of our body.

These very thin membranes are made up of cholesterol, essential fats, proteins and carbohydrates; and can be changed by what we eat. We are interested in the membranes’ health and the things we can do to make them healthier. We encourage healthy diets that have a good balance levels of essential fats. We often test the health of the membranes with bioimpedance to see how well they are working. Sometimes we check red blood cell fatty acid profiles to see if our red cell membranes have fat ratios that promote health.

Viruses, pesticides, heavy metals or saturated fats affect how our membranes communicate with each other and how well our cells can repair or reproduce. Omega-3 fat acids and polyunsaturated fats, fish oil and flaxseed oil actually change how much inflammation occurs in our bodies. These fats can affect how frequently we have irregular heart rhythm, and which genes are turned on and off that affect our health. It is through this appreciation for cell membrane structure that we’ve gained a greater appreciation for structure at the cellular level and how it affects our health.

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